4. Discussion
Nowadays, it is unimaginable to perform surgical procedures without surgical gloves. However, this study showed that wearing gloves disadvantageously affects tactile sensibility. Especially in disciplines such as microsurgery, where a high level of tactile sensibility is indispensable, this might prove problematic.
As studies using existing sensibility tests (SW-monofilament, 2PD) already found, gloved hands have a lower cutaneous sensibility than bare hands [5,9]. This we were able to confirm. However, our results are in contrast to Bucknor et al. (2011) [5], who reported no objective difference between different glove types regarding static and dynamic 2PD, although a difference in subjective preference was observed [5]. Studies comparing the tactile performance of different glove types, using the SW-monofilaments [2,5] and Roughness Discrimination Test [6], did not find significant differences between them, either [2]. In contrast, we noticed that Gammex Latex Sensitive™ gloves provide significantly better tactile sensibility than the other glove types.
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The reason therefore is not clear. Gammex Latex Sensitive gloves are made of thinner material compared to the other gloves, yet some of the competing gloves have comparable properties (Table 2). This may cause a higher acceptance quality level (AQL), even though the thinner material increases the chance of leaks. At the same time, a daily dependent market price analysis of size 7.0 gloves showed, that the significantly better sensibility may come with higher financial expenses. One must bear in mind, that careful choices in surgical equipment can significantly reduce costs, as a national audit of the NHS in Scotland showed: They spend approximately £2.6 million per year on surgical gloves alone [5,10]. Therefore, the choice of glove must remain well balanced between cost and clinician preference.
Double-gloving did not affect 2PD- and SW- discrimination in our study. In many different specialties, surgeons use double gloving, as it effectively reduces the risks of needlestick injuries and blood contact during surgery and thus the transmission of infections between the surgeon and patient [5,6,[11], [12], [13]]. Most glove manufacturers also advertise double gloving without significantly reduced sensibility. Novak et al. (1999) [14] examined the tactile sensibility of 25 surgeons wearing no, single and double latex gloves, using cutaneous pressure thresholds, moving and static 2PD for the dominant hand index finger. In contrast to our results, they found significant differences in tactile sensibility between single- and double-gloved hands [14]. However, this study is more than 20 years old, therefore in the comparison may be poor due to the constant advances in medical products. Likewise, Wilson et al. (1996) [6] compared single with double gloves in 32 surgeons, aiming to assess their effects on comfort, sensibility and dexterity. They concluded, that double gloves may protect the surgeon against needlestick injuries, but can reduce subjective comfort, sensibility and dexterity [6].
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A conceivable reason for oversized gloves is the increased wearing comfort. However, our study demonstrated that this might cause significant deterioration of tactile sensibility. Undersized gloves have no influence thereupon, but are associated with reduced wearing comfort.
Therefore, choosing the appropriate glove size is important to avoid significantly reduced tactile sensibility, as well as discomfort. Besides, the impact of different glove types must not be underestimated.
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